Fludarabine is a chemotherapy drug used in the treatment of cancer. It is most commonly utilized for patients with B-cell chronic lymphocytic leukemia, although it can be used for other cancers involving the blood. It is usually provided as part of a combination therapy regimen with other chemotherapy drugs.
The pyrimidine analogue, cytarabine, has been used effectively against a wide variety of acute leukemias. The success of cytarabine prompted a search for other potentially useful analogues. Fludarabine is a fluorinated analogue of adenine which is relatively resistant to deamination by adenosine deaminase. It is rapidly metabolized by deoxycytidine kinase to 2FaraATP which inhibits DNA synthesis by inhibition of DNA polymerases, and prevention of elongation of DNA strands through direct incorporation into the DNA molecule. It also inhibits RNA polymerase and protein synthesis.
This medication is in a class of chemotherapy drugs that work by attacking metabolic processes within the cancer cells. The drug inhibits the growth of cancerous cells and eventually forces cancer cells to die. It can be very effective in patients who have not responded to primary treatment.
Chemotherapy drugs are very strong, and fludarabine can come with serious side effects. As it attacks cancerous blood cells, it can also damage healthy cells. The drug causes anemia, with the lowest blood cell counts occurring approximately two weeks after the medication ha6s been administered. Patients on this drug have severely weakened immune systems and are highly vulnerable to infections, particularly pneumonia. Prophylactic drugs may be offered to prevent infection if a patient’s oncologist is concerned.
In a dosefinding study, severe irreversible central nervous system effects, including blindness, demyelination, coma and death, were seen in 36% of patients receiving four times the recommended dose for chronic lymphocytic leukemia. Symptoms appeared from 21 to 60 days post dosing. These effects are rare (0.2%) at the recommended dose. Fludarabine(CAS No. 21679-14-1) in combination with pentostatin (deoxycoformycin) results in an unacceptably high incidence of fatal pulmonary toxicity, and concomitant use is contraindicated.
One serious potential side effect is tumor lysis syndrome. This complication can also be seen with some other chemotherapy drugs. It occurs when cancer cells rapidly break up. This can cause kidney failure. If a patient has difficulty urinating or notices decreased urine output after a fludarabine treatment, the doctor should be notified. People will need to take precautions to avoid exposure to infectious organisms. Even mild infections can be dangerous because the patient’s immune system lacks the ability to successfully eliminate fungi, bacteria, viruses, and protozoans.
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